Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

BLOG: Functional medicine

Functional medicine is a philosophy or model of patient care that determines how and why illness occurs and restores health by addressing the root causes of disease for each individual, according to the Institute for Functional Medicine.

It was developed in the early 1990s by Jeffrey Bland, PhD, a biochemist who was the co-founder of the institute.

This organization was developed to provide education and support for the philosophy of functional medicine across disciplines within the health care sector. The goal is the prevention and management of chronic disease utilizing appropriate tools, including nutrition, lifestyle, exercise, environment, structural, cognitive, emotional and pharmaceutical therapies to meet the individual needs of the patient. The institute expanded its base of medical professionals eligible for certification to include optometry in October 2018.

There is a faction within the medical community, often referred to as organized or allopathic medicine, that dismisses functional medicine as alternative medicine or pseudo medicine. This group, however, was very slow to accept the germ theory of disease in the late 1800s and still considers osteopathic medicine, chiropractic, vision therapy and myopia control as examples of alternative medicine. They purport to have a medical discipline that uses “evidence-based” practice; however only evidence from their own sources is acceptable.

In spite of the resistance by this group, functional medicine has become accepted practice at some of the most prestigious medical centers in the U.S. Both the Cleveland Clinic and the Mayo Clinic have new clinical programs for functional and integrative medicine.

The concepts of functional medicine are starting to shape some of the thinking in optometry without being recognized. For example, dry eye has been traditionally considered a lack of tears, with the treatment being artificial tear drops. Today we consider dry eye as a symptom of underlying ocular surface disease, and comprehensive work-up can often determine a root cause that can be treated with diet or dietary supplements.

Many of the leaders of the functional medicine movement are looking at optometry as a significant new vector in the fight against chronic medical problems in America. New tools such as OCT and OCT angiography (OCTA) can be used by the optometrist to see early evidence of neurologic and vascular disease and open doors to prevention or management. A new study in China published this year found that changes in the nerve fiber layer as measured by OCT correlate with atrophy in the brain and cognitive decline (Shi et al.) In another study at Northwestern University, a strong correlation was seen between cognitive decline in Alzheimer’s disease and the perifoveal blood vessels as measured with OCT-A (Zhang et al.).

Early identification of chronic medical problems with noninvasive testing by the family optometrist using tools such as OCT can help to identify a potential root cause that could lead to prevention. We know that this is pretty straightforward for problems such as diabetes, hypertension and dyslipidemia, but this new evidence for a role in neurologic disease may be even more compelling.

Functional medicine offers even more strategies for optometrists using detailed health surveys and blood tests that can be employed in optometric primary care to provide more comprehensive care and preserve a lifetime of good vision.

Optometrists, with our large numbers, diverse geography and annual access to a vast number of young, healthy patients can be the leaders in this new aspect of primary health care.


References:

Expanded certification program provides more opportunity for medical professionals to practice functional medicine [press release]. PR Newswire; October 2, 2018.

Shi Z, et al. Front Aging Neurosci. 2019;doi:org/10.3389/fnagi.2019.00069.

Zhang YS, et al. PLoS ONE. 2019;doi:org/10.1371/journal.pone.0214685.